Bone fractures in children and adolescents: a frequent problem with a diverse aetiology

Bone fractures in children and adolescents are primarily an orthopaedic problem; however, frequent fractures or multiple fractures at a time require a more extensive diagnostic investigation performed by a paediatrician, endocrinologist and even a geneticist. It is estimated that one in three children aged up to 17 years will experience a bone fracture. The frequency of fractures rises with age, peaking at 11–14 years. The majority of fractures happen as a result of trauma; however, some of them are a sign of genetic diseases (osteogenesis imperfecta, osteopetrosis) or mineral imbalance (metabolic bone disease of prematurity, rickets, osteoporosis). Bone fractures in small children require particular attention, since they may be a sign of not only systemic disorders, but also of battered child syndrome. Not only fractures of long bones, but also fractures of the vertebrae are an underappreciated problem in young patients. They may be spontaneous or associated with inflammatory, autoimmune or neoplastic diseases. Glucocorticoids that are used to treat these diseases are considered to be the main risk factor for the development of steroid-related osteoporosis, regardless of the patient’s age. Due to the diverse aetiology of bone fractures in children and adolescents, the cooperation of multiple specialists in the diagnostic investigation of calcium and phosphate imbalance and disorders of bone mineralisation is important.